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272 Economic crisis, health systems and health in Europe: country experience
this link needs to be better analysed in the future. 15 Lower premiums and the
limited choice of health care provider for patients can only partly be related to
the crisis as it is also the result of the market regulation introduced in 2006.
Health insurers have now become accustomed to their new roles as purchasers
of care and have succeeded in achieving a stronger bargaining position vis-àvis
health providers. Whether the limited choice of provider will cause access
problems for patients will become clearer in the years to come.
4.3 Quality of care and user experience
There is currently no evidence that quality of care has been affected by the crisis.
There has been no increase in waiting times for curative care and they do not
seem to be excessive. (In the area of curative care, health insurers are responsible
for helping patients to find alternative providers if the waiting lists are long.) In
the area of long-term care, the percentage of patients waiting for admission to
inpatient long-term care facilities who waited longer than the normative waiting
time increased by 6–11 percentage points between 2010 and 2012 and by
14–21 percentage points for nursing homes. No changes in waiting times were
observed for patients in need of inpatient mental health care (93% of patients
were admitted within the normative waiting time; Dutch Health Care Authority,
2013). However, a periodical survey conducted by the Netherlands Institute for
Social Research (Sociaal en Cultureel Planbureau) among 1307 Dutch citizens in
2013 showed that 11% of respondents saw health care and care for older people
as the largest social problem and the top priority for the country (Dekker et al.,
2013). Other issues that were considered to be of top priority were the economy
and income (17%), social norms and values (17%) and crime. Citizens were
also increasingly worried about the effects of cuts on the quality of care (Dekker
et al., 2013). However, it also has to be noted that some measures have been
taken to protect the quality of health care. For example, investments in medical
education were protected from the cuts until 2013.
4.4 Impact on efficiency
Even before the crisis, the 2006 reform promoted improving the efficiency of
health care delivery. The efficiency-improving measures are still being continued
and have not been affected by the crisis. For example, the reform included
measures such as the programme introducing logistic principles known as “faster,
better” (Vos et al., 2008). The reform also promoted delegation of tasks from
physicians to less-expensive, suitably trained health care professionals, such as
nurses (see section 3.4). This should improve the multidisciplinary collaboration
15 The ability to reduce premiums for the basic package might also have been the result of the savings accumulated by
insurers. The financial results of health insurers (for the basic package and VHI together) have been positive since 2008
(Foundation for Pharmaceutical Statistics, 2012).